The Malta Independent 20 June 2021, Sunday

It’s not a choice - eating disorder awareness

Saturday, 29 May 2021, 09:09 Last update: about 21 days ago

Annabel Cuff

In the past, eating disorders tended to be seen as affecting mainly young females, however we now know more about them and realise that they are ubiquitous.

They affect people from diverse backgrounds, all over the globe. The Faculty for Social Wellbeing at the University of Malta keenly believes in raising awareness on social issues, and we wish to bring the issue of eating disorders to the forefront of public consciousness.


People suffering from an eating disorder do not make a choice to become anorexic, or to binge eat – eating disorders are severe mental disturbances, driven by psychological factors.

Persons with eating disorders attempt to exert control over emotional or psychological distress, either by restricting their food intake, or because they lose control over their food consumption.

At any point in time, several million people across the globe are suffering from an eating disorder. The most well-known eating disorders are Anorexia Nervosa – where the person restricts food intake and has an extreme fear of gaining any weight; Bulimia Nervosa – characterised by uncontrollable, frequent binges, accompanied by extreme efforts to avoid gaining weight; and Binge Eating Disorder - recurring and uncontrollable episodes of excessive food consumption over a short period of time, unaccompanied by compensatory behaviours such as purging or excessive exercise.

Another lesser known eating disorder, which seems to be significantly on the rise, is ARFID (Avoidant/Restrictive Food Intake Disorder), previously known as Selective Eating Disorder.

ARFID is characterised by a persistent inability to meet appropriate alimentary or energy requirements. As with all eating disorders, ARFID centres on controlling food intake, but the difference is that it does not involve thoughts of body image. It may arise out of escalating picky eating; food traumas, such as near choking on a food item that then becomes increasingly impossible to eat; or sensory issues with food, where foods of certain tastes or consistencies become intolerable.

Of all the eating disorders, ARFID is the one that most affects children, however it is present in adults too and can emerge in adulthood as well as in early childhood. Because ARFID is often seen as picky eating, and to some extent we acknowledge that this occurs in children, it can remain undiagnosed and therefore escalate. Like all eating disorders, it causes great physical, emotional and psychological distress.

Eating disorders have various medical and psychological effects. They disrupt natural growth, have detrimental effects on the circulation and nervous system, can cause cardiac and renal difficulties and chronic pain. Some of these effects can be reversed if normal eating patterns resume, however, some health consequences can be lasting – particularly if the person has been living with an eating disorder for a long time. Generally, the sooner a disorder is diagnosed and treated, the better the outcome for the person. Besides impacting health, eating disorders cause significant disturbance to an individual's social and psychological wellbeing. The self-esteem issues brought on, or exacerbated, by an eating disorder, as well as the time taken up thinking about and maintaining it, often trigger feelings of shame and cause sufferers to shun people for fear of being judged. This self-imposed isolation continues to feed the disorder, causing a cycle that can be extremely hard to break. Eating disorders have the highest mortality rate of all the psychological illnesses.

There is usually not one main cause for an eating disorder, however diets and social media images of super-thin or overly muscled ‘beautiful people’ and influencers do not help.

Modern-day standards of idealised beauty, both male and female, are pretty impossible. In fact, it is believed that the modern ideal female shape is 23% thinner than what is considered an average, healthy weight. On the other hand, male idealised images tend to present toned, muscled types – equally unrealistic in real life.

The result is that male eating disorder sufferers tend to want to gain weight and be more muscled, as opposed to female sufferers who generally wish to be thinner. It is time to start looking critically at these images: is it achievable? Is it healthy? Thankfully, there is growing consciousness of the imperative of self-acceptance and a number of social media accounts exist that focus on body positivity or aim to expose the truth behind perfectly posed influencer images – showing how small changes in lighting or in how a person is posed will deliver photos that look leaner or more muscled than when seen in relaxed pose by the naked eye.

Yet, eating disorders continue to live among us. A study carried out in 2012 by the National Statistics office (NSO), which helped set up Dar Kenn għal Saħħtek, Malta’s facility for the treatment of eating disorders and obesity, found that the prevalence of eating disorders in 15 to 50-year olds in Malta was comparable to that in other European countries.

In 2020 the Faculty for Social Wellbeing carried out a study for Dar Kenn għal Saħħtek which examined the prevalence of eating disorders among youths in Malta aged 10 to16 years.

The nationally representative study found that eating disorders are prevalent in 5% of Maltese 10 to 16-year olds. This means that out of the youth population of 10 to 16-year olds, (which at the time of the study, was just under 30,500), around 1,675 have an eating disorder. This is an inordinate amount of young people to be suffering from the fear, shame, distress and debilitating physical effects of an eating disorder.

As well as raising general awareness, we wish to send a message of hope – if you or anyone you know has an eating disorder please do not face this alone. There are several websites dedicated to information about eating disorders, or to how one can help a loved one with an eating disorder. And of course, Dar Kenn għal Saħħtek  runs various programmes all the year round. Help is available and recovery is possible. Many people who recover from eating disorders go on to have healthy and fulfilled lives.

Annabel Cuff is a Research Support Officer II at the Faculty for Social Wellbeing

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